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Omeprazole Treatment of Children With Peptic Esophagitis Refractory to Ranitidine Therapy

Omeprazole Treatment of Children With Peptic Esophagitis Refractory to Ranitidine Therapy Abstract Objective: To evaluate the cause of chronic abdominal pain lasting more than 3 weeks in 153 patients aged 6 to 18 years (mean, 9.9 years) who had undergone endoscopy. Design: Those patients with peptic esophagitis as the cause of their chronic pain were treated with high-dose ranitidine hydrochloride, followed by the proton-pump inhibitor, omeprazole, for those who did not respond to a histamine2-receptor antagonist. Results: Eighty-four percent of patients had peptic esophagitis, 3% had Helicobacater pylori gastritis, and 3% had ulcer disease. Seventy percent of the patients with peptic esophagitis responded to an 8-week course of high-dose ranitidine hydrochloride (4 mg/kg per dose, twice a day or three times a day). Of the 30% of patients who failed to respond to ranitidine therapy, 87% responded to an 8-week course of omeprazole (20 mg/d). The grade of esophagitis at initial endoscopy was a predictive factor for response to ranitidine therapy. Ninety percent of patients with grade 1 esophagitis responded to ranitidine therapy vs only 43% of those with grade 3 or 4 esophagitis. Only five patients (4%) failed to respond to both therapies; three of these subsequently underwent Nissen fundoplications. There were no side effects of either ranitidine or omeprazole therapy. Conclusions: These findings indicate that (1) peptic esophagitis was a common cause of chronic abdominal pain in pediatric patients and (2) omeprazole was effective in the treatment of esophagitis in children and adolescents that was resistant to high-dose histamine2receptor antagonists.(Arch Pediatr Adolesc Med. 1995;149:267-271) References 1. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 2. Oster J. Recurrent abdominal pain, headaches, and limb pains in children and adolescents . Pediatrics . 1972;50:429-436. 3. Johanessen T. Symptoms of esophagitis in general practice . In: Sanberg N, Walen A, eds. Function and Disease of the Esophagus . Philadelphia, Pa: Smith Kline & French; 1985:77-78. 4. Feldman M, Burton ME. Histamine 2 receptor antagonist: standard therapy for acid-peptic disease . N Engl J Med . 1990;323:1672-1680.Crossref 5. Koelz HR. Treatment of reflux esophagitis with H2-blockers antacids and prokinetic drugs: an analysis of randomized clinical trials . Scand J Gastroenterol . 1989;24( (suppl 156) ):25-36. 6. Klinkenberg-Knol EC, Jansen KMBJ, Fosten HMP, Meuwissen SGM, Lamers CBHW. Double blind multicenter comparison of omeprazole and ranitidine in the treatment of reflux esophagitis . Lancet . 1987:1:349-351.Crossref 7. Vantrappen G, Rutgersts L, Schurmans P, Coenegrachts JL. Omeprazole (40 milligrams) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis . Dig Dis Sci . 1988;33:523-529.Crossref 8. Havelund T, Laursen L, Skoubo-Kristensen E, et al. Omeprazole and ranitidine in treatment of reflux esophagitis: double blind comparative trial . BMJ . 1988; 296:89-92.Crossref 9. Koop H, Hotz J, Pommer G, Kllein M, Arnold R. Prospective evaluation of omeprazole treatment in reflux esophagitis refractory to H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:593-599.Crossref 10. Lloyd-Davies KA, Rutgersson K, Solvell L. Omeprazole in the treatment of Zollinger-Ellison syndrome: a 4-year international study . Aliment Pharmacol Ther . 1988; 2:13-32.Crossref 11. Kato S, Shibuya H, Hayashi Y, Tseng SW, Nakagawa H, Ohi R. Effectiveness 12. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 13. Oster J. Recurrent abdominal pain, headaches, and limb pains in children and adolescents . Pediatrics . 1972;50:429-436. 14. Johanessen T. Symptoms of esophagitis in general practice . In: Sanberg N, Walen A, eds. Function and Disease of the Esophagus . Philadelphia, Pa: Smith Kline & French; 1985:77-78. 15. Feldman M, Burton ME. Histamine 2 receptor antagonist: standard therapy for acid-peptic disease . N Engl J Med . 1990;323:1672-1680.Crossref 16. Koelz HR. Treatment of reflux esophagitis with H2-blockers antacids and prokinetic drugs: an analysis of randomized clinical trials . Scand J Gastroenterol . 1989;24( (suppl 156) ):25-36. 17. Klinkenberg-Knol EC, Jansen KMBJ, Fosten HMP, Meuwissen SGM, Lamers CBHW. Double blind multicenter comparison of omeprazole and ranitidine in the treatment of reflux esophagitis . Lancet . 1987:1:349-351.Crossref 18. Vantrappen G, Rutgersts L, Schurmans P, Coenegrachts JL. Omeprazole (40 milligrams) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis . Dig Dis Sci . 1988;33:523-529.Crossref 19. Havelund T, Laursen L, Skoubo-Kristensen E, et al. Omeprazole and ranitidine in treatment of reflux esophagitis: double blind comparative trial . BMJ . 1988; 296:89-92.Crossref 20. Koop H, Hotz J, Pommer G, Kllein M, Arnold R. Prospective evaluation of omeprazole treatment in reflux esophagitis refractory to H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:593-599.Crossref 21. Lloyd-Davies KA, Rutgersson K, Solvell L. Omeprazole in the treatment of Zollinger-Ellison syndrome: a 4-year international study . Aliment Pharmacol Ther . 1988; 2:13-32.Crossref 22. Kato S, Shibuya H, Hayashi Y, Tseng SW, Nakagawa H, Ohi R. Effectiveness and pharmacokinetics of omeprazole in children with refractory duodenal ulcer . J Pediatr Gastroenterol Nutr . 1992;15:184-188.Crossref 23. Dalzell AM, Searle JW, Patrick MK. Treatment of refractory ulcerative esophagitis with omeprazole . Arch Dis Child . 1992;67:641-642.Crossref 24. Gunasekaran TS, Hassall EG. Efficacy and safety of omeprazole for severe gastroesophageal reflux in children . J Pediatr . 1993;123:148-154.Crossref 25. Kilbridge PM, Dahms BB, Czinn SJ. Campylobacter pylori-associated gastritis and peptic ulcer disease in children . AJDC . 1988;142:1149-1152. 26. Herbst JJ. Gastroesophageal reflux . J Pediatr . 1981;88:859-870.Crossref 27. Baslisteri WF, Ferrell MK. Gastroesophageal reflux in infants . N Engl J Med . 1983;309:790-792.Crossref 28. Hixson LJ, Kelley CL, Jones WN, Tuohy CD. Current trends in the pharmacotherapy of gastroesophageal reflux disease . Arch Intern Med . 1992;152:714-723.Crossref 29. Sontag SJ. Rolling review: gastro-esophageal reflux disease . Aliment Pharmacol Ther . 1993;7:293-312.Crossref 30. Colin-Jones DG. Histamine receptor antagonists in gastroesophageal reflux . Gut . 1989;30:1305-1308.Crossref 31. Collen MJ, Lewis JH, Benjamin SB. Gastric acid hypersecretion in refractory gastroesophageal reflux disease . Gastroenterology . 1990;98:654-661. 32. Somogyi A, Becker M, Gugler. Cimetidine pharmacokinetics and dosage requirements in children . Eur J Pediatr . 1985;144:72-76.Crossref 33. Blumer JL, Rothstein FC, Kaplan BS, et al. Pharmacokinetic determination of ranitidine pharmacodynamics in pediatric ulcer disease . J Pediatr . 1985:107: 301-306.Crossref 34. Lundell L, Backman L, Ekstrom P, et al. Omeprazole or high-dose ranitidine in the treatment of patients with reflux esophagitis not responding to standard doses of H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:145-155.Crossref 35. Wolf MM, Soil AH. The physiology of gastric acid secretion . N Engl J Med . 1988;319:1705-1715. 36. Fellenius E, Elander B, Wallmark B, Helander HF, Berglindh T. Inhibition of acid secretion in isolated gastric glands by substituted benzimidazoles . Am J Physiol . 1982;243:G505-G510. 37. Clissold SP, Campoli-Richards DM. Omeprazole . Drugs . 1986;32:15-47.Crossref 38. Olbe L, Lind T, Cederberg C, Ekenved G. Effect of omeprazole on gastric acid secretion in man . Scand J Gastroenterol . 1986;18( (suppl 21) ):105-107.Crossref 39. Gugler R, Fuchs G, Dieckmann M, Somogyi AA. Cimetidine plasma concentrations-response relationships . Clin Pharmacol Ther . 1981;29:744-748.Crossref 40. Lind T, Cederberg C, Ekvenved G, Haglund U, Olbe L. Effect of omeprazole—a gastric proton pump inhibitor—on pentagastrin stimulated acid secretion in man . Gut . 1983:24:270-276.Crossref 41. Bardham KD. Is there any acid peptic disease that is refractory to proton pump inhibitors? Aliment Pharmacol Ther . 1993;7( (suppl 1) ):13-24.Crossref 42. Farup PG. Compliance with anti-ulcer medication during short term healing phase clinical trials . Aliment Pharmacol Ther . 1992;6:179-186.Crossref 43. De Boer WA, Tytgat GNJ. Review article: drug therapy for reflux esophagitis . Aliment Pharmacol Ther . 1994;8:147-157.Crossref 44. Joelson S, Joelson IB, Lungdorg P, Walan A, Wallander MA. Safety experience from long-term treatment with omeprazole . Digestion . 1992;51( (suppl 1) ):93-101.Crossref 45. McTavish D, Buckley MM, Heel RC. Omeprazole. Drugs . 1991;42:138-170.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Omeprazole Treatment of Children With Peptic Esophagitis Refractory to Ranitidine Therapy

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References (36)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1995.02170150047007
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To evaluate the cause of chronic abdominal pain lasting more than 3 weeks in 153 patients aged 6 to 18 years (mean, 9.9 years) who had undergone endoscopy. Design: Those patients with peptic esophagitis as the cause of their chronic pain were treated with high-dose ranitidine hydrochloride, followed by the proton-pump inhibitor, omeprazole, for those who did not respond to a histamine2-receptor antagonist. Results: Eighty-four percent of patients had peptic esophagitis, 3% had Helicobacater pylori gastritis, and 3% had ulcer disease. Seventy percent of the patients with peptic esophagitis responded to an 8-week course of high-dose ranitidine hydrochloride (4 mg/kg per dose, twice a day or three times a day). Of the 30% of patients who failed to respond to ranitidine therapy, 87% responded to an 8-week course of omeprazole (20 mg/d). The grade of esophagitis at initial endoscopy was a predictive factor for response to ranitidine therapy. Ninety percent of patients with grade 1 esophagitis responded to ranitidine therapy vs only 43% of those with grade 3 or 4 esophagitis. Only five patients (4%) failed to respond to both therapies; three of these subsequently underwent Nissen fundoplications. There were no side effects of either ranitidine or omeprazole therapy. Conclusions: These findings indicate that (1) peptic esophagitis was a common cause of chronic abdominal pain in pediatric patients and (2) omeprazole was effective in the treatment of esophagitis in children and adolescents that was resistant to high-dose histamine2receptor antagonists.(Arch Pediatr Adolesc Med. 1995;149:267-271) References 1. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 2. Oster J. Recurrent abdominal pain, headaches, and limb pains in children and adolescents . Pediatrics . 1972;50:429-436. 3. Johanessen T. Symptoms of esophagitis in general practice . In: Sanberg N, Walen A, eds. Function and Disease of the Esophagus . Philadelphia, Pa: Smith Kline & French; 1985:77-78. 4. Feldman M, Burton ME. Histamine 2 receptor antagonist: standard therapy for acid-peptic disease . N Engl J Med . 1990;323:1672-1680.Crossref 5. Koelz HR. Treatment of reflux esophagitis with H2-blockers antacids and prokinetic drugs: an analysis of randomized clinical trials . Scand J Gastroenterol . 1989;24( (suppl 156) ):25-36. 6. Klinkenberg-Knol EC, Jansen KMBJ, Fosten HMP, Meuwissen SGM, Lamers CBHW. Double blind multicenter comparison of omeprazole and ranitidine in the treatment of reflux esophagitis . Lancet . 1987:1:349-351.Crossref 7. Vantrappen G, Rutgersts L, Schurmans P, Coenegrachts JL. Omeprazole (40 milligrams) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis . Dig Dis Sci . 1988;33:523-529.Crossref 8. Havelund T, Laursen L, Skoubo-Kristensen E, et al. Omeprazole and ranitidine in treatment of reflux esophagitis: double blind comparative trial . BMJ . 1988; 296:89-92.Crossref 9. Koop H, Hotz J, Pommer G, Kllein M, Arnold R. Prospective evaluation of omeprazole treatment in reflux esophagitis refractory to H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:593-599.Crossref 10. Lloyd-Davies KA, Rutgersson K, Solvell L. Omeprazole in the treatment of Zollinger-Ellison syndrome: a 4-year international study . Aliment Pharmacol Ther . 1988; 2:13-32.Crossref 11. Kato S, Shibuya H, Hayashi Y, Tseng SW, Nakagawa H, Ohi R. Effectiveness 12. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 13. Oster J. Recurrent abdominal pain, headaches, and limb pains in children and adolescents . Pediatrics . 1972;50:429-436. 14. Johanessen T. Symptoms of esophagitis in general practice . In: Sanberg N, Walen A, eds. Function and Disease of the Esophagus . Philadelphia, Pa: Smith Kline & French; 1985:77-78. 15. Feldman M, Burton ME. Histamine 2 receptor antagonist: standard therapy for acid-peptic disease . N Engl J Med . 1990;323:1672-1680.Crossref 16. Koelz HR. Treatment of reflux esophagitis with H2-blockers antacids and prokinetic drugs: an analysis of randomized clinical trials . Scand J Gastroenterol . 1989;24( (suppl 156) ):25-36. 17. Klinkenberg-Knol EC, Jansen KMBJ, Fosten HMP, Meuwissen SGM, Lamers CBHW. Double blind multicenter comparison of omeprazole and ranitidine in the treatment of reflux esophagitis . Lancet . 1987:1:349-351.Crossref 18. Vantrappen G, Rutgersts L, Schurmans P, Coenegrachts JL. Omeprazole (40 milligrams) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis . Dig Dis Sci . 1988;33:523-529.Crossref 19. Havelund T, Laursen L, Skoubo-Kristensen E, et al. Omeprazole and ranitidine in treatment of reflux esophagitis: double blind comparative trial . BMJ . 1988; 296:89-92.Crossref 20. Koop H, Hotz J, Pommer G, Kllein M, Arnold R. Prospective evaluation of omeprazole treatment in reflux esophagitis refractory to H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:593-599.Crossref 21. Lloyd-Davies KA, Rutgersson K, Solvell L. Omeprazole in the treatment of Zollinger-Ellison syndrome: a 4-year international study . Aliment Pharmacol Ther . 1988; 2:13-32.Crossref 22. Kato S, Shibuya H, Hayashi Y, Tseng SW, Nakagawa H, Ohi R. Effectiveness and pharmacokinetics of omeprazole in children with refractory duodenal ulcer . J Pediatr Gastroenterol Nutr . 1992;15:184-188.Crossref 23. Dalzell AM, Searle JW, Patrick MK. Treatment of refractory ulcerative esophagitis with omeprazole . Arch Dis Child . 1992;67:641-642.Crossref 24. Gunasekaran TS, Hassall EG. Efficacy and safety of omeprazole for severe gastroesophageal reflux in children . J Pediatr . 1993;123:148-154.Crossref 25. Kilbridge PM, Dahms BB, Czinn SJ. Campylobacter pylori-associated gastritis and peptic ulcer disease in children . AJDC . 1988;142:1149-1152. 26. Herbst JJ. Gastroesophageal reflux . J Pediatr . 1981;88:859-870.Crossref 27. Baslisteri WF, Ferrell MK. Gastroesophageal reflux in infants . N Engl J Med . 1983;309:790-792.Crossref 28. Hixson LJ, Kelley CL, Jones WN, Tuohy CD. Current trends in the pharmacotherapy of gastroesophageal reflux disease . Arch Intern Med . 1992;152:714-723.Crossref 29. Sontag SJ. Rolling review: gastro-esophageal reflux disease . Aliment Pharmacol Ther . 1993;7:293-312.Crossref 30. Colin-Jones DG. Histamine receptor antagonists in gastroesophageal reflux . Gut . 1989;30:1305-1308.Crossref 31. Collen MJ, Lewis JH, Benjamin SB. Gastric acid hypersecretion in refractory gastroesophageal reflux disease . Gastroenterology . 1990;98:654-661. 32. Somogyi A, Becker M, Gugler. Cimetidine pharmacokinetics and dosage requirements in children . Eur J Pediatr . 1985;144:72-76.Crossref 33. Blumer JL, Rothstein FC, Kaplan BS, et al. Pharmacokinetic determination of ranitidine pharmacodynamics in pediatric ulcer disease . J Pediatr . 1985:107: 301-306.Crossref 34. Lundell L, Backman L, Ekstrom P, et al. Omeprazole or high-dose ranitidine in the treatment of patients with reflux esophagitis not responding to standard doses of H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:145-155.Crossref 35. Wolf MM, Soil AH. The physiology of gastric acid secretion . N Engl J Med . 1988;319:1705-1715. 36. Fellenius E, Elander B, Wallmark B, Helander HF, Berglindh T. Inhibition of acid secretion in isolated gastric glands by substituted benzimidazoles . Am J Physiol . 1982;243:G505-G510. 37. Clissold SP, Campoli-Richards DM. Omeprazole . Drugs . 1986;32:15-47.Crossref 38. Olbe L, Lind T, Cederberg C, Ekenved G. Effect of omeprazole on gastric acid secretion in man . Scand J Gastroenterol . 1986;18( (suppl 21) ):105-107.Crossref 39. Gugler R, Fuchs G, Dieckmann M, Somogyi AA. Cimetidine plasma concentrations-response relationships . Clin Pharmacol Ther . 1981;29:744-748.Crossref 40. Lind T, Cederberg C, Ekvenved G, Haglund U, Olbe L. Effect of omeprazole—a gastric proton pump inhibitor—on pentagastrin stimulated acid secretion in man . Gut . 1983:24:270-276.Crossref 41. Bardham KD. Is there any acid peptic disease that is refractory to proton pump inhibitors? Aliment Pharmacol Ther . 1993;7( (suppl 1) ):13-24.Crossref 42. Farup PG. Compliance with anti-ulcer medication during short term healing phase clinical trials . Aliment Pharmacol Ther . 1992;6:179-186.Crossref 43. De Boer WA, Tytgat GNJ. Review article: drug therapy for reflux esophagitis . Aliment Pharmacol Ther . 1994;8:147-157.Crossref 44. Joelson S, Joelson IB, Lungdorg P, Walan A, Wallander MA. Safety experience from long-term treatment with omeprazole . Digestion . 1992;51( (suppl 1) ):93-101.Crossref 45. McTavish D, Buckley MM, Heel RC. Omeprazole. Drugs . 1991;42:138-170.Crossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Mar 1, 1995

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